Time filter

Source Type

Homkham N.,Institute Of Recherche Pour Le Developpement Ird Umi 174 Phpt | Homkham N.,Chiang Mai University | Homkham N.,Kasetsart University | Homkham N.,University Paris Saclay | And 24 more authors.
Pediatric Infectious Disease Journal | Year: 2015

In 188 HIV-infected children receiving efavirenz, a lower middose (C12) was associated with a higher risk of HIV-1 viral load >400 copies/ mL (P = 0.03). Simulations for a normalized population receiving US Food and Drug Administration weight-band dosing predicted that 15% of children would have a C12 below target threshold (<1.0 mg/L) with a 23% risk of viral replication. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.


Cressey T.R.,Chiang Mai University | Cressey T.R.,Harvard University | Cressey T.R.,CIRAD - Agricultural Research for Development | Jourdain G.,Chiang Mai University | And 14 more authors.
AIDS | Year: 2010

Objective: To evaluate the pharmacokinetics and HIV viral load response following initiation during the third trimester of pregnancy of zidovudine plus standard-dose lopinavir boosted with ritonavir (LPV/r), twice daily, until delivery for the prevention of mother-to-child transmission of HIV. Design: Prospective study nested within a multicenter, three-arm, randomized, phase III prevention of mother-to-child transmission of HIV trial in Thailand (PHPT-5, ClinicalTrials.gov Identifier: NCT00409591). Methods: Women randomized to receive 300 mg zidovudine and 400/100 mg LPV/r twice daily from 28 weeks gestation, or as soon as possible thereafter, until delivery had intensive steady-state 12-h blood sampling performed. LPV/r pharmacokinetic parameters were calculated using noncompartmental analysis. Rules were defined a priori for a LPV/r dose escalation based on the proportion of women with an LPV area under the concentration-time curve (AUC) below 52 μg h/ml (10th percentile for LPV AUC in nonpregnant adults). HIV-1 RNA response was assessed during the third trimester. Results: Thirty-eight women were evaluable; at entry, median (range) gestational age was 29 (28-36) weeks, weight 59.5 (45.0-91.6) kg, CD4 cells count 442 (260-1327) cells/μl and HIV-1 RNA viral load 7818 (<40-402 015) copies/ml. Geometric mean (90% confidence interval) LPV AUC, Cmax and Cmin were 64.6 (59.7-69.8) μg h/ml, 8.1 (7.5-8.7) μg/ml and 2.7 (2.4-3.0) μg/ml, respectively. Thirty-one of 38 (81%) women had an LPV AUC above the AUC target. All women had a HIV-1 viral load less than 400 copies/ml at the time of delivery. Conclusion: A short course of zidovudine plus standard-dose LPV/r initiated during the third trimester of pregnancy achieved adequate LPV exposure and virologic response. © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Fregonese F.,Chiang Mai University | Fregonese F.,CIRAD - Agricultural Research for Development | Fregonese F.,Harvard University | Fregonese F.,University of Padua | And 23 more authors.
Journal of Acquired Immune Deficiency Syndromes | Year: 2012

Objective: To estimate the early and long-term mortalities and associated risk factors in adults receiving highly active antiretroviral therapy (HAART) in Thailand. Design: A prospective observational cohort study. Methods: Previously untreated adults starting HAART in 2002-2009 were followed-up in 43 public hospitals. Kaplan-Meier probability of survival was estimated up to 5 years of therapy. Factors associated with early (≤6 months) and long-term (>6 months) mortalities were assessed using Cox regression analyses. Results: A total of 1578 adults received HAART (74% women; median age, 33 years; CD4 cell count, 124/mL), with a median followup of 50 months (interquartile range, 41-66). Eighty-nine patients (6%) died (37 occurred ≤6 months and 52 occurred >6 months) and 183 (12%) were lost to follow-up. Probability of survival [95% confidence interval (CI)] was 97.5% (96.7% to 98.2%) at 6 months, 96.6% (95.6% to 97.4%) at 1 year, and 93.5% (91.9% to 94.8%) at 5 years. Probability of being alive and on follow-up was 80.8% (78.5% to 82.8%) at 5 years. Early mortality was associated with anemia [adjusted hazard ratio (aHR) 3.6, 95% CI: 1.7 to 7.5] and low CD4 count (aHR 1.6, 95% CI: 1.1 to 2.2 per 50 cells decrease) at treatment initiation. Long-term mortality was associated with persistent anemia (aHR 4.9, 95% CI: 2.1 to 11.6), CD4 increase from baseline ,50 cells per cubic millimeter (aHR 3.1, 95% CI: 1.6 to 5.7), and viral load >1000 copies per milliliter (aHR 2.8, 95% CI: 1.3 to 6.1) at 6 months of HAART; male gender; and calendar year of enrollment. Conclusions: Early mortality was associated with anemia and severe immunosuppression at initiation of therapy. Long-term mortality was associated with persistent anemia, CD4 count increase, and virological response at 6 months of therapy over baseline characteristics, highlighting the importance of laboratory monitoring. Copyright © 2012 by Lippincott Williams & Wilkins.


Riyaten P.,Chiang Mai University | Riyaten P.,Institute Of Recherche Pour Le Developpement Ird Umi 174 Phpt | Salvadori N.,Institute Of Recherche Pour Le Developpement Ird Umi 174 Phpt | Salvadori N.,Chiang Mai University | And 29 more authors.
Journal of Acquired Immune Deficiency Syndromes | Year: 2015

Background: Use of several antiretrovirals (ARVs) has been shown to be associated with a higher risk of diabetes in HIV-infected adults. We estimated the incidence of new-onset diabetes and assessed the association between individual ARVs and ARV combinations, and diabetes in a large cohort in Thailand. Methods: We selected all HIV-1-infected, nondiabetic, antiretroviral-naive adults enrolled in the Program for HIV Prevention and Treatment cohort (NCT00433030) between January 2000 and December 2011. Diabetes was defined as confirmed fasting plasma glucose ≤126 mg/dL or random plasma glucose ≤200 mg/dL. Incidence was the number of cases divided by the total number of person-years of follow-up. Association between ARVs and ARV combinations, and new-onset diabetes was assessed using Cox proportional hazards models. Results: Overall, 1594 HIV-infected patients (76% female) were included. Median age at antiretroviral therapy initiation was 32.5 years. The incidence rate of diabetes was 5.0 per 1000 person-years of followup (95% confidence interval: 3.8 to 6.6) (53 cases). In analyses adjusted for potential confounders, exposure to stavudine + didanosine [adjusted hazard ratio (aHR) = 3.9; P = 0.001] and cumulative exposure ≤1 year to zidovudine (aHR = 2.3 vs. no exposure; P = 0.009) were associated with a higher risk of diabetes. Conversely, cumulative exposure≤1 year to tenofovir (aHR = 0.4 vs. no exposure; P = 0.02) and emtricitabine (aHR = 0.4 vs. no exposure; P = 0.03) were associated with a lower risk. Conclusions: The incidence of diabetes in this predominantly female, young, lean population was relatively low. Although stavudine and didanosine have now been phased out in most antiretroviral therapy programs, our analysis suggests a higher risk of diabetes with zidovudine, frequently prescribed today in resource-limited settings. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.


Aekplakorn W.,Mahidol University | Tantayotai V.,Walailak University | Numsangkul S.,Khon Buri Hospital | Sripho W.,Nakhon Ratchasima City Municipality | And 14 more authors.
Journal of Diabetes Research | Year: 2015

Aim. To evaluate an agreement in identifying dysglycemia between fasting plasma glucose (FPG) and the 2 hr postprandial glucose tolerance test (OGTT) in a population with high risk of diabetes. Methods. A total of 6,884 individuals aged 35-65 years recruited for a community-based diabetes prevention program were tested for prediabetes including impaired fasting glucose (IFG) or impaired glucose tolerance (IGT), and diabetes. The agreement was assessed by Kappa statistics. Logistic regression was used to examine factors associated with missed prediabetes and diabetes by FPG. Results. A total of 2671 (38.8%) individuals with prediabetes were identified. The prevalence of prediabetes identified by FPG and OGTT was 32.2% and 22.3%, respectively. The proportions of diabetes classified by OGTT were two times higher than those identified by FPG (11.0% versus 5.4%, resp.). The Kappa statistics for agreement of both tests was 0.55. Overall, FPG missed 46.3% of all prediabetes and 54.7% of all diabetes cases. Prediabetes was more likely to be missed by FPG among female, people aged <45 yrs, and those without family history of diabetes. Conclusion. The detection of prediabetes and diabetes using FPG only may miss half of the cases. Benefit of adding OGTT to FPG in some specific groups should be confirmed. © 2015 Wichai Aekplakorn et al.


Suaysod R.,Chiang Mai University | Ngo-Giang-Huong N.,Chiang Mai University | Ngo-Giang-Huong N.,Harvard University | Salvadori N.,Chiang Mai University | And 17 more authors.
Clinical Infectious Diseases | Year: 2015

Background: Human immunodeficiency virus (HIV)-infected children failing second-line antiretroviral therapy (ART) have no access to third-line antiretroviral drugs in many resource-limited settings. It is important to identify risk factors for second-line regimen failure. Methods: HIV-infected children initiating protease inhibitor (PI)-containing second-line ART within the Program for HIV Prevention and Treatment observational cohort study in Thailand between 2002 and 2010 were included. Treatment failure was defined as confirmed HIV type 1 RNA load >400 copies/mL after at least 6 months on second-line regimen or death. Adherence was assessed by drug plasma levels and patient self-report. Cox proportional hazards regression analyses were used to identify risk factors for failure. Results: A total of 111 children started a PI-based second-line regimen, including 59 girls (53%). Median first-line ART duration was 1.9 years (interquartile range [IQR], 1.4-3.3 years), and median age at second-line initiation was 10.7 years (IQR, 6.3-13.4 years). Fifty-four children (49%) experienced virologic failure, and 2 (2%) died. The risk of treatment failure 24 months after second-line initiation was 41%. In multivariate analyses, failure was independently associated with exposure to first-line ART for >2 years (adjusted hazard ratio [aHR], 1.8; P =. 03), age >13 years (aHR, 2.9; P <. 001), body mass index-for-age z score < -2 standard deviations at second-line initiation (aHR, 2.8; P =. 03), and undetectable drug levels within 6 months following second-line initiation (aHR, 4.5; P <. 001). Conclusions: Children with longer exposure to first-line ART, entry to adolescence, underweight, and/or undetectable drug levels were at higher risk of failing second-line ART and thus should be closely monitored. © 2015 The Author 2015.


PubMed | Pakplee Hospital, Nonghualing Health Center, Thatphanom Crown Prince Hospital, Samutsakhon Hospital and 8 more.
Type: | Journal: Journal of diabetes research | Year: 2015

To evaluate an agreement in identifying dysglycemia between fasting plasma glucose (FPG) and the 2hr postprandial glucose tolerance test (OGTT) in a population with high risk of diabetes.A total of 6,884 individuals aged 35-65 years recruited for a community-based diabetes prevention program were tested for prediabetes including impaired fasting glucose (IFG) or impaired glucose tolerance (IGT), and diabetes. The agreement was assessed by Kappa statistics. Logistic regression was used to examine factors associated with missed prediabetes and diabetes by FPG.A total of 2671 (38.8%) individuals with prediabetes were identified. The prevalence of prediabetes identified by FPG and OGTT was 32.2% and 22.3%, respectively. The proportions of diabetes classified by OGTT were two times higher than those identified by FPG (11.0% versus 5.4%, resp.). The Kappa statistics for agreement of both tests was 0.55. Overall, FPG missed 46.3% of all prediabetes and 54.7% of all diabetes cases. Prediabetes was more likely to be missed by FPG among female, people aged <45yrs, and those without family history of diabetes.The detection of prediabetes and diabetes using FPG only may miss half of the cases. Benefit of adding OGTT to FPG in some specific groups should be confirmed.


PubMed | Samutsakhon Hospital, Phayao Provincial Hospital, Kalasin Hospital, Chiang Mai University and 3 more.
Type: Journal Article | Journal: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America | Year: 2015

Human immunodeficiency virus (HIV)-infected children failing second-line antiretroviral therapy (ART) have no access to third-line antiretroviral drugs in many resource-limited settings. It is important to identify risk factors for second-line regimen failure.HIV-infected children initiating protease inhibitor (PI)-containing second-line ART within the Program for HIV Prevention and Treatment observational cohort study in Thailand between 2002 and 2010 were included. Treatment failure was defined as confirmed HIV type 1 RNA load >400 copies/mL after at least 6 months on second-line regimen or death. Adherence was assessed by drug plasma levels and patient self-report. Cox proportional hazards regression analyses were used to identify risk factors for failure.A total of 111 children started a PI-based second-line regimen, including 59 girls (53%). Median first-line ART duration was 1.9 years (interquartile range [IQR], 1.4-3.3 years), and median age at second-line initiation was 10.7 years (IQR, 6.3-13.4 years). Fifty-four children (49%) experienced virologic failure, and 2 (2%) died. The risk of treatment failure 24 months after second-line initiation was 41%. In multivariate analyses, failure was independently associated with exposure to first-line ART for >2 years (adjusted hazard ratio [aHR], 1.8; P = .03), age >13 years (aHR, 2.9; P < .001), body mass index-for-age z score < -2 standard deviations at second-line initiation (aHR, 2.8; P = .03), and undetectable drug levels within 6 months following second-line initiation (aHR, 4.5; P < .001).Children with longer exposure to first-line ART, entry to adolescence, underweight, and/or undetectable drug levels were at higher risk of failing second-line ART and thus should be closely monitored.


Poosawang W.,Samutsakhon Hospital | Kiatkungwankai P.,Samutsakhon Hospital
Journal of the Medical Association of Thailand | Year: 2013

Pancreatic schwannoma is an extremely rare neoplasm, derived from Schwann cells that line the nerve sheaths. It is also referred to as neurilemmoma. The authors report a case of a 46-year-old Thai female who presented with dyspepsia, weight loss and epigastric mass. An examination by ultrasonography and computed tomography (CT) scan revealed a septated cystic tumor in the pancreatic head, 5.8x5.5x5.3 cm in size. Pancreaticoduodenectomy was performed to remove this tumor. A microscopic examination identified proliferating spindle cells that are consistent with neurilemmoma (schwannoma). No complications were found after the operation. At 18-month follow-up, the patient remains asymptomatic and has no signs of recurrence.


PubMed | Samutsakhon Hospital
Type: Case Reports | Journal: Journal of the Medical Association of Thailand = Chotmaihet thangphaet | Year: 2013

Pancreatic schwannoma is an extremely rare neoplasm, derived from Schwann cells that line the nerve sheaths. It is also referred to as neurilemmoma. The authors report a case of a 46-year-old Thai female who presented with dyspepsia, weight loss and epigastric mass. An examination by ultrasonography and computed tomography (CT) scan revealed a septated cystic tumor in the pancreatic head, 5.8x5.5x5.3 cm in size. Pancreaticoduodenectomy was performed to remove this tumor. A microscopic examination identified proliferating spindle cells that are consistent with neurilemmoma (schwannoma). No complications were found after the operation. At 18-month follow-up, the patient remains asymptomatic and has no signs of recurrence.

Loading Samutsakhon Hospital collaborators
Loading Samutsakhon Hospital collaborators